How much control do clinicians really have over billing?

In practices nationwide, the power to write off patient charges is no longer fully in clinicians’ hands. With larger, more centralized billing systems, providers often have limited flexibility—even when they want to lessen the financial burden of healthcare for their patients.

Insurance gaps, rising costs, and administrative policies all play a role in shaping how, and if, clinicians can reduce bills. On Healthcasts, our community shared how much flexibility they have when it comes to writing off overdue charges, and the ways they’re adapting in today’s environment. 

Are you able to write off overdue charges to assist struggling patients? Log in or sign up to read the full post, leave a comment, and see the Consensus. 

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 Comments

Key takeaways about writing off overdue patient charges: 

• Autonomy over billing decisions is shrinking
  Many clinicians—especially in hospital-owned settings—can no longer write off charges, as financial decisions are increasingly centralized.
  
• Clinicians are finding workarounds
  To assist patients who are struggling, providers are using tactics like downcoding, discounts, or removing select charges to help reduce patient costs.
  
• Balancing care with financial reality
  Private practice clinicians still have some flexibility, but must weigh patient support against the financial sustainability of their practice.
  

Internal Medicine

"The practice is owned by the hospital. I am an employee of theirs, therefore it’s not my decision on being able to write off any debts. I can see a patient and put a no-charge visit, but that is about all the freedom that I have on this issue. Years ago, when I owned my practice, I had the freedom to instruct office girls to w/o or not to charge out a visit; it was my practice and my decision."

Family Practice

"I work for a large multi-specialty group. I cannot 'write off' bills, but I can look into most and help maneuver the system. If there was an outrageous charge, for example, for a wart cryotherapy treatment, I can remove that charge if they have terrible insurance and it is not covered."

Unspecified/Other

"I work in an underserved loan repayment area, so there is a sliding scale set up for cash patients to help reduce costs. Usually, there is a bit of down-coding thrown in as well."

Family Practice

"When I was part of a smaller private practice, I could write off any charges, and I did, and I loved it. Now I am part of a very large group, and it is out of my control, sadly."

Surgeons

"I have the ability to write off bills, and do this in some circumstances. I also do not charge copays when patients are legitimately struggling."

Internal Medicine

"I loved the luxury you mentioned about writing off unpaid charges, especially since I was able not send bills to colleagues and their families. I am still able to write off, however, if my employer is paying me full salary, I don’t feel comfortable with this."

Family Practice

"I am in private practice and, yes, we have the ability to write off past-due charges, and I do this for those who are struggling financially. For those who I know can pay, we offer reduced rates and/or payment plans before sending them to collections."

Family Practice

"Since I joined the hospital as a primary physician, I am no longer involved in billing and can’t write off bills. I do, however, substantially “under bill “ for my services for those I know cannot afford the full fee. It does reflect in my productivity, but also provides good word-of-mouth referrals and improves my standing in the community. I think it also reduces no-shows."

Family Practice

"We don’t have the ability to write off, but can do a cash discount of 30%, and there’s a 20% bill deduction if paid in full in March - April."

Internal Medicine

"In a current financially strained private practice, writing off patients' debt is impossible for the survival of the practice. We will set up payment plans with patients."

How does your practice handle overdue patient bills? Share your experience and read all of the comments on the post on Healthcasts.